Federal Court Rules That Vulnerable New York City Residents Face Excessive Delays In Medicaid Home Health Care Program
(New York, NY – October 5, 2010) – After four years of litigation, needy New York City residents who rely on Medicaid-funded home health care won an important victory last Friday when United States District Judge Richard J. Holwell certified a Plaintiff class and awarded summary judgment against two New York State agencies, finding excessive delays in the implementation of often life-saving benefits to which Plaintiffs are entitled. In Shakhnes v. Eggleston, the Court agreed with Plaintiffs and ruled that the New York State Office of Temporary and Disability Assistance and the New York State Department of Health (“State Defendants”) systemically violated federal law and regulations by failing to timely resolve and implement State Fair Hearing decisions within 90 days of clients’ appeals, resulting in grave harm to vulnerable New York City residents. The Court ruled: “Just as justice delayed is justice denied, so too is action delayed action denied.” Sandra Hauser of SNR Denton, one of the lead attorneys for Plaintiffs, explained that, “Judge Holwell’s decision will help ensure that vulnerable New York City residents who need home health services will receive the care they so desperately need with the federally mandated time limits.”
Jane Greengold Stevens of the New York Legal Assistance Group, a lead attorney for Plaintiffs, began several years ago to see home health care clients facing severe problems with delay. Ms. Stevens explained that, under the federal Medicaid system, States are required to provide an opportunity for appeal, through a “Fair Hearing” process, to any individual whose claim for assistance is denied or not acted upon, or whose benefits are terminated or reduced. Final administrative action – including an evidentiary hearing on the appeal, the rendering of a decision, and final implementation of any administrative ruling – must occur within ninety days of any request for such a hearing. Ms. Stevens described the extreme delay that clients, including lead Plaintiff, were facing: “Plaintiff Boris Shakhnes, for example, who suffers from multiple sclerosis, waited more than seven months for State Defendant to even schedule a Fair Hearing after his doctor’s request for an increase in care was denied. During the many months he went without the care to which he was legally entitled, Mr. Shakhnes suffered greatly, enduring severe pain, bedsores, and anxiety, posing a serious threat to his health and safety.” Judge Holwell also recognized the extreme delays and pointed out the case of Named Plaintiff Fei Mock, who suffers from severe scoliosis that renders her unable to walk or stand on her own, and waited more than six months before her evidentiary hearing was even scheduled. Judge Holwell explained that, “the cases where a Ms. Mock is lying in bed unattended because the government has not decided whether she needs someone to help her turn over in bed or use the bathroom overnight, those are the cases where the State takes the longest to resolve an appeal.”
Finding that Plaintiffs have a right of action to enforce the applicable provisions of the Medicaid Act, Judge Holwell agreed that, with a few exceptions, a Plaintiff’s “right is violated when the agency fails to carry the hearing through all steps necessary to completion with ninety days of the request for the hearing.” In the same Order, Judge Holwell certified a plaintiff class, denied in part State Defendants’ arguments in favor of dismissal of the case, and denied efforts by the New York City Human Resource Administration (“City Defendant”) to secure summary judgment in its favor, as well as Plaintiffs’ bid for summary judgment against City Defendant. Plaintiffs’ delay claims against City Defendant remain pending and will be subject to further adjudication.
Plaintiffs are represented by co-lead attorneys from the New York Legal Assistance Group (NYLAG), a not-for-profit public interest law firm based in Manhattan, and the New York office of SNR Denton.
The New York Legal Assistance Group (NYLAG) provides free civil legal services to New Yorkers who cannot afford a private attorney. Founded in 1990, NYLAG works to empower individuals, protect fundamental legal rights, and promote access to justice. With a reputation for responding quickly to emerging community needs, the agency offers a broad range of high quality and culturally competent services. For more information, go to www.nylag.org.